The position of the brow and the amount of skin in the upper lids are intimately related.  If a brow is elevated, this pulls skin out of the upper lid.  If the brow is very low, skin on the upper lid can accumulate.  When assessing upper lids, it is also important to assess the brow.  If the brow is very low, an upper lid blepharoplasty alone may not be enough to correct the excess skin and a brow lift may need to be performed at the same time.  There are three forms of brow lift:

This is a procedure in which an ellipse of skin is removed directly above the eyebrows.  The scar may be placed either within the eyebrow or within a nearby crease and is usually of good quality. 

This is a simple procedure that can be performed under local or general anaesthetic with a short down-time.  It tends to be used in older patients, especially men, with very low brows and plenty of creases around the eyebrow region in which to hide the scars. 

This is a procedure in which the brow is elevated by making an incision in the scalp that passes within the hairline or along the hairline. 

The incision passes from just above one ear to just above the other ear.  The whole brow is elevated through this incision.  At the same time, the muscles that cause creases just above the nose can be adjusted or removed. 

This procedure takes approximately 2 hours and it can be combined with other procedures such as a face lift or the treatment of upper/lower eyelids.  The scar is hidden within the hairline and is usually of good quality. 

Complications include numbness of the scalp behind the scar and, very occasionally, weakness of the muscles that elevate the brow. 

It takes approximately 1-2 weeks for the bruising to settle down after surgery.  Initially, the brow may be a little high and this usually settles down within 6 weeks.

Endoscopic brow lifting is a similar procedure to an open brow lift although the incision length is shorter.  The procedure is performed with an operating telescope and is performed through 5 incisions in the scalp.  It takes approximately 2 hours to perform this procedure and it tends to produce less numbness in the scalp than the open brow lift but may not be quite as powerful at elevating very heavy or very low brows.  The bruising and swelling takes approximately 2 weeks to settle down.  Numbness of the forehead can occur but is unusual and weakness to the muscles that elevate the brow is also a potential but uncommon complication.